Michael Dueñas, OD is chief public health officer of the American Optometric Association. The St. Louis-based organization made news recently for its efforts to develop a Measures and Outcomes Registry for Eyecare (MORE) with data from an initial set of six EHR vendors – Eyecare Advantage from Compulink Business Systems, MaximEyes from First Insight, RevolutionEHR from Health Innovation Technologies, Eyefinity EHR, Crystal Practice Management, and Practice Director EHR from Williams Group.

Tell me about yourself and the AOA.I have been with the association a little over 6 years. I came to the AOA as President Obama came into office, leaving my post in as a health scientist at the CDC just as my wife was recruited by the new administration to serve in a senior position at EPA headquarters in Washington, D.C. While at the CDC, I served on the ONC’s Review Task Force and helped establish vision modules for national surveys (BRFSS and NHANES); and on the Podiatry, Pharmacy, Optometry and Dentistry (PPOD) working group of the National Diabetes Education Program (NDEP), framed by an operational example of my own practice’s integrated clinical approach to diabetes care.

Prior to the CDC, my professional experience included private clinical and hospital-based optometry practice, teaching, and applied research with a focus on the public health and epidemiology of diabetes and other chronic diseases.

With regard to the AOA, it represents 33,000 doctors of optometry and optometry students. Optometrists serve patients in nearly 6,500 communities across the country, and are the only eye doctors in 3,500 of those communities.

What was the impetus for creating the MORE registry project?The registry project, the first of its kind for optometry, was initiated by the AOA Board of Trustees in response to the growing emphasis on quality reporting and measurements through registries as part of healthcare. It will allow optometry, as a profession, to analyze clinical outcomes for the benefit of improving care over time. It will also enable us to advocate to insurance regulators, state legislatures, and the public about the services and value of our profession. For example, with data from MORE, we can advocate to the media and public about patient demographics and the quality eye exams we collectively perform.

Why were the six initial EHR vendors chosen to contribute registry data? Is AOA be open to working with additional vendors in the future? MORE requires the use of one of our approved EHR vendors. The list of approved vendors is constantly expanding. AOA has worked with these initial EHR vendors to ensure that data entered into the electronic exam record of ODs flows accurately to MORE. A cloud based platform is a necessity.

Each week, the participating EHR vendors send clinical data from their systems to MORE’s receiving area. It is not going into EHRs to get data. The information is “pushed” from their EHR to MORE by systems their EHR vendors put into place. Data is encrypted using industrial-strength encryption and remains encrypted while in transit and at rest. Once the data has been validated and processed, it is imported into the registry where it is stored securely.

MORE will expand to add additional EHR vendors. We track EHR vendors in use by ODs and the demand for additional vendors going forward. In addition, we encourage ODs to let their vendor know their preference to participate in the registry.

How long do you anticipate the registry will be in development? The short answer is it will be in constant development and will keep abreast and ahead of federal requirements. Its query functionality will enable us to better understand how and where to expand its functions to provide essential data to improve healthcare systems and remain more patient centered in our care.

What do you hope AOA members will use it for once its operational? ODs will be able to access statistics derived from their own patient base by viewing the AOA MORE dashboard. The registry is preprogrammed to provide statistics on many topics including patient demographics compared to national averages; most common diagnosis codes compared to national averages; and most common medicines prescribed compared to national averages. Benchmarking is a privately viewed comparison of an OD’s care to the profession as a whole. For example, ODs can see their individual performance rates on PQRS measures or the number of glaucoma patients they diagnose compared to national registry averages in optometry.

MORE will also help ODs stay compliant by tracking encamps, and assist with Meaningful Use Stages 2 and 3 and PQRS reporting. In MU2, optometrists need to meet core objectives, menu set objectives and also CQM objectives. In general for CQMs, optometrists must meet nine different CQM objectives to satisfy MU2 criteria. Examples include recording full medication lists our patients are using, screening for tobacco use, and sending a letter to a primary care physician when our patient has diabetic retinopathy.

The same logic is now applying to PQRS. We must meet nine different objectives to avoid a PQRS penalty. Some of the ideas will overlap (sending a letter to a PCP about diabetic retinopathy is found in both PQRS and as a CQM in MU2).

Why did you choose to partner with Prometheus Research on the registry project? We partnered with Prometheus Research because of their experience and reputation in developing high-quality registries. They have spent the past decade building integrated registries to address the challenges of acquiring, integrating, and repurposing health data for biomedical researchers, academic health centers, philanthropic institutions, and professional societies. Staffed by a unique combination of clinical research informaticians and open-source software engineers, they stand apart from traditional “registry” companies with a partnership model that avoids software licensing fees and vendor lock-in strategies. Instead, they are in favor of empowering their clients to the point that they will no longer need most — if not all — of expert data management consultation from Prometheus once the registry is completely built and running. Of course, Prometheus Research will continue to house and maintain the registry for AOA into the future and make improvements as needed.

How have you seen AOA members embrace healthcare IT like EHRs over the last several years? Doctors of optometry have participated in the Medicare and Medicaid EHR incentive programs in strong numbers. Since its inception, nearly 17,000 doctors of optometry have enrolled to participate in the Medicare or Medicaid EHR incentive programs and more than 12,000 have achieved Meaningful Use. Optometrists treat millions of Medicare and Medicaid beneficiaries annually, and the AOA encourages its members to use EHRs to enhance that care.

A registry will allow ODs to participate in the new value-based payment system that Medicare and other insurers are using. Participation in a registry is one of the requirements for maximum reimbursement rates by Medicare. This new Merit-based Incentive Payment System (MIPS) includes PQRS, Meaningful Use, and other clinical quality improvement measures.

Do you anticipate any barriers to MORE adoption? 2017 PQRS data will be the first time AOA MORE is able to submit to CMS on behalf of optometrists (reported by the end of February 2018). This means that even though ODs will be using AOA MORE during 2015 and 2016, they will still need to submit their own PQRS data (either claims-based or EHR-based) during 2015 and 2016.

A noted barrier includes the CMS rule that requires any registry to be functioning for one full year prior to applying for qualified status. Think of this CMS requirement as a registry "practice year." CMS wants to ensure that every registry is properly working for one year before they deem it an official “qualified” registry for PQRS. Furthermore, the CMS rule states that registry start dates must be January 1 of a given year. With these CMS rules in mind, AOA will get doctors integrated and acclimated to MORE during 2015 and beyond. While you will be able to view your PQRS dashboard metrics in MORE during this time, it will not be officially submit your PQRS data to CMS until early 2018 for your 2017 data. Continue to submit on your own for your patients in 2015 and 2016.

That being said, MORE advantages include ease of use and cost. As I mentioned previously, there is no manual entry required for MORE, and members can sign into MORE using their AOA.org login credentials. MORE is a member benefit to those who are current with their dues. Non-AOA members will pay $1,800 per year to use it.

Do you have any final thoughts? In addition to the advocacy efforts I mentioned, AOA is using the new registry to apply for its first ever CMS TCPI Support and Alignment Network Grant for $3 million over four years. MORE will also provide de-identified data that may better describe the importance of a comprehensive eye exam by a doctor of optometry to children entering first grade, where currently two in five children begin first grade anchored by refractive errors, focusing issues, and alignment difficulties. These are most often missed by vision screening, which suffers a 73-percent error rate.

In closing, I learned very well while I was at the CDC that, “In God we trust, all others bring data.” Through MORE, the AOA will now have that data.